NOVANT MEDICAL GROUP (NPI# 1215484340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215484340 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP |
| Other Organization Name | NOVANT HEALTH MULTIDISCIPLINARY CANCER CLINIC |
| Practice Address |
1010 Bethesda Ct Winston Salem NC 27103-3019 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3362776600 |
| Practice Fax Number | 3367189733 |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2020-08-04 |
| Authorized Official Name | SHALA DAVIS (RCS MANAGER) |
| Authorized Official Telephone | 7043167845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Cancer Institute | Doing Business As Name - Organization |
| Novant Health Multidisciplinary Cancer Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669620910 | Novant Medical Group | Family Medicine | 143 Marginal Street, Cooleemee, NC 27014-0910 | 2008-08-28 |
| 1063833424 | Novant Medical Group | Internal Medicine | 1718 E 4th St, Suite 401, Charlotte, NC 28204-3261 | 2014-01-02 |
| 1689917783 | Novant Medical Group | Internal Medicine | 5175 Old Clemmons School Rd, Clemmons, NC 27012-9087 | 2013-03-27 |
| 1982945242 | Novant Medical Group | Obstetrics & Gynecology | 2711 Randolph Rd, Suite 512, Charlotte, NC 28207-2034 | 2013-03-12 |
| 1447504063 | Novant Medical Group | Dietitian, Registered | 1710 Kernersville Medical Pkwy, Suite 210, Kernersville, NC 27284-7157 | 2012-11-05 |
| 1255689212 | Novant Medical Group | Orthopaedic Surgery | 1401 Matthews Township Pkwy Ste 210, Matthews, NC 28105-5403 | 2012-08-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Novant Medical Group Inc. | 2626 Glenwood Ave Ste 550, Raleigh, NC 27608 |
| Virginia Business Entities | Novant Medical Group Inc. | 2085 Frontis Plaza Blvd, Winston Salem, North Carolina 27103 |
| System for Award Management (SAM) Entities | NOVANT MEDICAL GROUP, INC. | 200 Hawthorne Ln, Charlotte, NC 28204-2515 |
| Street Address |
1010 BETHESDA CT |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245210707 | Piedmont Hematology-oncology Associates, Pllc | Internal Medicine | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2006-01-20 |
| 1497361455 | Dominika Bajguz | Genetic Counselor, MS | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2020-09-16 |
| 1003300609 | Daria Wuycik Wooten | Pharmacist | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2018-06-18 |
| 1083119366 | Sarah Caitlin Hughes | Genetic Counselor, MS | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2018-03-28 |
| 1104321470 | Erica Lynn Cousins | Genetic Counselor, MS | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2018-03-28 |
| 1659737757 | Novant Medical Group, Inc | Internal Medicine | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2016-01-06 |
| 1649635954 | Novant Medical Group, Inc | Internal Medicine | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2015-12-31 |
| 1912348483 | Novant Medical Group Inc | Hospitalist | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2013-07-12 |
| 1083934343 | Elizabeth Miles Haynes | Physician Assistant | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2010-06-09 |
| 1154560621 | Sarah Rebecca Johnson | Nurse Practitioner | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2009-02-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558627794 | Thomas William Lycan Jr. | Internal Medicine | Wake Forest Medical Center, Winston Salem, NC 27157 | 2012-04-02 |
| 1619594777 | Elizabeth Grace St. Amand | Internal Medicine | 1 Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-07-06 |
| 1477114585 | Laura Michelle Welsh | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2019-06-28 |
| 1326532565 | Jonathan David Mcguirt | Internal Medicine | 3333 Silas Creek Pkwy, Winston Salem, NC 27103 | 2018-06-20 |
| 1033622618 | Forsyth Memorial Hospital, Inc | Internal Medicine | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2017-11-06 |
| 1487008447 | Forsyth Memorial Hospital, Inc. | Internal Medicine | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2016-04-15 |
| 1659737757 | Novant Medical Group, Inc | Internal Medicine | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2016-01-06 |
| 1649635954 | Novant Medical Group, Inc | Internal Medicine | 1010 Bethesda Ct, Winston Salem, NC 27103-3019 | 2015-12-31 |
| 1447679113 | Jonathan Edward Lambird | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-3003 | 2014-04-10 |
| 1174941355 | Emily Hughes Douglas | Internal Medicine | Medical Center Boulevard, Winston Salem, NC 27157-0816 | 2014-04-03 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.